基于脑fMRI对偏头痛再认识及解郁和中法辨治偏头痛经验
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摘要
基于脑功能磁共振技术(functional magnetic resonance imaging, f MRI)研究,认为偏头痛属于中枢神经系统类疾病的范畴,并且认为长期疼痛发作的累积效应导致了偏头痛患者脑功能网络的异常。笔者从肝脾胃失调立论,治疗偏头痛从整体观念和脏腑辨证出发,遵循"方从法出""法随证立",临床中运用自拟解郁和中汤,病证结合,方证相应,脏腑同调兼顾配合心理疏导、精神安慰等心身并治之法,临床获效满意。
Based on brain functional magnetic resonance imaging(f MRI) studies, it is considered that migraine is a central nervous system disease and the cumulative effect of long-term pain episodes leads to abnormal brain function network in migraine patients. From the viewpoint of liver, spleen, and stomach disorders, the author argues that treatment of migraine should be based on the holistic view and syndrome differentiation of the viscera and bowels and follow the principles of "Prescription from the law" and "The law based on evidence". The clinical application of self-made Jieyu Hezhong Decoction has the advantages of combining the disease and the syndrome and the correspondence between prescription and syndrome. Regulating the viscera and bowels together combined with psychological counseling, mental comfort, and other psychosomatic treatments have good effects.
Based on brain functional magnetic resonance imaging(f MRI) studies, it is considered that migraine is a central nervous system disease and the cumulative effect of long-term pain episodes leads to abnormal brain function network in migraine patients. From the viewpoint of liver, spleen, and stomach disorders, the author argues that treatment of migraine should be based on the holistic view and syndrome differentiation of the viscera and bowels and follow the principles of "Prescription from the law" and "The law based on evidence". The clinical application of self-made Jieyu Hezhong Decoction has the advantages of combining the disease and the syndrome and the correspondence between prescription and syndrome. Regulating the viscera and bowels together combined with psychological counseling, mental comfort, and other psychosomatic treatments have good effects.
引文
[1] YU S, CAO X, ZHAO G, et al. The burden of headache in China:validation of diagnostic questionnaire for a populationbased Survey[J]. Headache Pain, 2011,12(2):141-146.
[2]李婴婴,陈春富.偏头痛的性别差异[J].国际神经病学神经外科学杂志,2016,43(1):83-87.
[3]罗国刚,马玉青,苟静,等.偏头痛患者伴发焦虑/抑郁及功能残疾的临床研究[J].中国神经精神疾病杂志,2012,38(8):477-481.
[4] SCHWEDTTJ, DODICKDW. Advancedneuroimagingofmigraine[J]. Lancet Neurol, 2009, 8(6):560-568.
[5] KURTH T, MOHAMEDS, MAILLARD P, et al. Headache, migraine, and structural brain lesions and function:population based Epidemiology of Vascular Ageing-MRI study[J]. Bmj British Medical Journal, 2011, 342(7790):215-215.
[6] AMIN FM, ASGHAR MS, HOUGAARD A, et al. Magnetic resonance angiography of intracranial and extracranial artenies in patients with spontaneous migraine without aura:a cross-sectional study[J]. Lancet Neurol, 2013,12(5):454-461.
[7] MAINERO C, BOSHYAN J, HADJIKHANI N. Altered functional magnetic resonance imaging resting-state connectivity in periaqueductal gray networks in migraine[J]. Ann Neurol, 2011,70(5):838-845.
[8]宁艳哲,邹忆怀,刘宏伟,等.偏头痛疼痛相关脑网络的fMRI研究进展[J].辽宁中医杂志,2017,44(1):204-206.
[9]赵海娜,杨丽白,闫欣桐,等.偏头痛患者静息态功能磁共振自发脑活动改变的Meta分析[J].中国医刊,2018,53(2):150-155.
[10] MAY A. Neuroimaging:visualising the brain in pain[J]. Neurol Sci, 2007, 28(Suppl 2):S101-107.
[11]何莉娜,孙景波,华荣.349例头风病患者证候观察[J].辽宁中医药大学学报,2010,12(1):136-137.
[12]胡穗发,胡小凤,彭天忠.柔肝愈偏饮防治肝郁血虚型偏头痛的临床研究[J].湖南中医药大学学报,2016,36(12):45-48.
[13]李郑生,郭淑云.李振华临证经验集[M].北京:科学出版社,2014:4.
[14]郭淑云.李振华诊治慢性萎缩性胃炎的思路与方药[J].辽宁中医杂志,2010,37(10):1883-1884.
[15]荣培晶,刘爱华,张建国,等.经皮耳迷走神经刺激治疗难治性癫痫的临床试验研究[J].世界科学技术-中医药现代化,2013,15(9):2011-2020.
[16] FANG J, RONG P, HONG Y, et al. Transcutaneous vagus nerve stimulation modulates default mode network in major depressive disorder[J]. Biol Psychiatry, 2016,79(4):266-273.
[17] GOADSBY P J, GROSBERG B M, MAUSKOP A. Effect of noninvasive vagus nerve stimulati-on on acute migraine:an open-label pilot study[J]. Cephalalgia, 2014,34(12):986-963.
[18]屈箫箫,邵娣,杨开洋.经皮耳迷走神经刺激预防性治疗偏头痛的临床疗效观察[J].陕西医学杂志,2017,46(9):1255-1257.
[19]杨佃会,马祖彬,韩晶,等.耳穴综合疗法治疗无先兆型偏头痛:多中心对照观察[J].中国针灸,2012,32(11):971-974.
[20]俞裕天,荣培晶,朱兵.经皮耳迷走神经刺激治疗脑病的现状与展望[J].世界科学技术-中医药现代化,2017,19(3):462-468.
[21] ROUND R, LITSCHER G, BAHR F. Auricular acupuncture with laser[J].Evid Based Complement Ahernat Med,2013,2013(3):1-22.
[2]李婴婴,陈春富.偏头痛的性别差异[J].国际神经病学神经外科学杂志,2016,43(1):83-87.
[3]罗国刚,马玉青,苟静,等.偏头痛患者伴发焦虑/抑郁及功能残疾的临床研究[J].中国神经精神疾病杂志,2012,38(8):477-481.
[4] SCHWEDTTJ, DODICKDW. Advancedneuroimagingofmigraine[J]. Lancet Neurol, 2009, 8(6):560-568.
[5] KURTH T, MOHAMEDS, MAILLARD P, et al. Headache, migraine, and structural brain lesions and function:population based Epidemiology of Vascular Ageing-MRI study[J]. Bmj British Medical Journal, 2011, 342(7790):215-215.
[6] AMIN FM, ASGHAR MS, HOUGAARD A, et al. Magnetic resonance angiography of intracranial and extracranial artenies in patients with spontaneous migraine without aura:a cross-sectional study[J]. Lancet Neurol, 2013,12(5):454-461.
[7] MAINERO C, BOSHYAN J, HADJIKHANI N. Altered functional magnetic resonance imaging resting-state connectivity in periaqueductal gray networks in migraine[J]. Ann Neurol, 2011,70(5):838-845.
[8]宁艳哲,邹忆怀,刘宏伟,等.偏头痛疼痛相关脑网络的fMRI研究进展[J].辽宁中医杂志,2017,44(1):204-206.
[9]赵海娜,杨丽白,闫欣桐,等.偏头痛患者静息态功能磁共振自发脑活动改变的Meta分析[J].中国医刊,2018,53(2):150-155.
[10] MAY A. Neuroimaging:visualising the brain in pain[J]. Neurol Sci, 2007, 28(Suppl 2):S101-107.
[11]何莉娜,孙景波,华荣.349例头风病患者证候观察[J].辽宁中医药大学学报,2010,12(1):136-137.
[12]胡穗发,胡小凤,彭天忠.柔肝愈偏饮防治肝郁血虚型偏头痛的临床研究[J].湖南中医药大学学报,2016,36(12):45-48.
[13]李郑生,郭淑云.李振华临证经验集[M].北京:科学出版社,2014:4.
[14]郭淑云.李振华诊治慢性萎缩性胃炎的思路与方药[J].辽宁中医杂志,2010,37(10):1883-1884.
[15]荣培晶,刘爱华,张建国,等.经皮耳迷走神经刺激治疗难治性癫痫的临床试验研究[J].世界科学技术-中医药现代化,2013,15(9):2011-2020.
[16] FANG J, RONG P, HONG Y, et al. Transcutaneous vagus nerve stimulation modulates default mode network in major depressive disorder[J]. Biol Psychiatry, 2016,79(4):266-273.
[17] GOADSBY P J, GROSBERG B M, MAUSKOP A. Effect of noninvasive vagus nerve stimulati-on on acute migraine:an open-label pilot study[J]. Cephalalgia, 2014,34(12):986-963.
[18]屈箫箫,邵娣,杨开洋.经皮耳迷走神经刺激预防性治疗偏头痛的临床疗效观察[J].陕西医学杂志,2017,46(9):1255-1257.
[19]杨佃会,马祖彬,韩晶,等.耳穴综合疗法治疗无先兆型偏头痛:多中心对照观察[J].中国针灸,2012,32(11):971-974.
[20]俞裕天,荣培晶,朱兵.经皮耳迷走神经刺激治疗脑病的现状与展望[J].世界科学技术-中医药现代化,2017,19(3):462-468.
[21] ROUND R, LITSCHER G, BAHR F. Auricular acupuncture with laser[J].Evid Based Complement Ahernat Med,2013,2013(3):1-22.
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